ORTHODONTISTS’, SENIOR DENTAL STUDENTS’ AND LAYPERSONS’ PERCEPTION OF ESTHETICS OF PATIENTS TREATED ORTHODONTICALLY WITH MAXILLARY CANINE SUBSTITUTION, MAXILLARY PREMOLAR SUBSTITUTION AND LOWER INCISOR EXTRACTION

Abstract

Introduction: Orthodontic treatment can camouflage the unesthetic dentalproblems such as, congenitally missing teeth, impacted teeth, skeletal-dental discrepancies, or a combination (Canut, 1996; Chawla et al., 2011). Orthodontic canine substitution is a procedure performed on patients with missing lateral incisors. This is a viable option for patients who elect not to prosthetically restore the missing teeth. In the process, canine teeth are moved into the lateral teeth positions, and the premolar teeth are positioned next to the canines (Kokich & Kinzer, 2005; Mazzini & Torres, 2017). Premolars may replace canines in conditions of impacted or untreatable pathological canines, where the impacted canines are determined to interfere with the development of adjacent teeth, or when the success of surgical exposure and orthodontics is unpredictable (Chawla et al., 2011). Similarly, lower incisors may be extracted and orthodontically replaced by adjacent teeth in to camouflage skeletal discrepancies, eliminate a Bolton discrepancy, relieve edge-to- edge anterior occlusion, correct Class III malocclusion, or to eliminate a severely blocked- out incisor (Bayram & Ozer, 2007). This study aims to investigate how different groups of individuals perceive the esthetic results of such treatments. Materials and Methods: A survey was administered to 15 orthodontists, 15 senior dental students and 15 laypeople via iPad. The survey requested subject gender and ethnicity, and used a Likert scale to rate the esthetics of different images of dentition post- treatment (3 canine substitution, 3 premolar substitution, 3 lower incisor extraction, and 3 control images of non-extraction dentition post-treatment). The Likert scale used was a continuous sliding scale from 0-10. Post-treatment photographs chosen utilized the frontal view in maximum intercuspation of patients who were treated at Temple University’s iii Orthodontics Clinic. Median scores were compared across groups using Kruskal-Wallis tests. Results: There were no significant differences across all three groups of subjects’ median ratings for all four types of treatment. There were no significant differences in preferences between genders and ethnicities. For all median ratings except for Canine 2 and Canine 3, all male scores were higher than female scores. For two of three canine images, females rated them higher than males. The image with the overall highest median rating across all subjects was Control 1. The camouflage treatment image with the overall highest median rating is Premolar 3. The camouflage treatment image with the overall lowest median rating is Canine 3. Though, none of these differences were significant. Conclusion: Orthodontists, senior dental students, and laypeople had no specific esthetic preferences. Orthodontic treatment outcomes were equivocally satisfactory for all surveyed subjects. Gender and ethnicity did not influence the degree of satisfaction. The orthodontist scores reflected their knowledge of the complexity of the case, whereas, the dental students paid attention to gingival margin heights and midlines, and color and shape of teeth. Straightness of teeth was preferred by the laypeople. Orthodontic camouflage treatment outcomes were equivocally satisfactory for all surveyed orthodontists, senior dental students, and laypeople, and there were no significant differences across all subjects’ median ratings.Oral Biolog